The Food Medic - S1 E9 - Periods, Fertility + the menopause

Episode Date: August 6, 2018

This week we have Dr.Anita Mitra on the show, a.k.a @gynaegeek, to talk about reproductive and hormone health from periods and PCOS, to fertility and contraception, and also the menopause. There’s something in there for everyone - including the men so make sure to have a listen and leave us a review and rating! You can find Anita on social media @gynaegeek or on her website www.gynaegeek.com. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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exclusions, and terms apply. Instacart, groceries that over-deliver. Hello, and welcome to the Food Medic podcast. I'm Dr. Hazel Wallace, founder of The Food Medic. I'm a qualified doctor, personal trainer, blogger, and best-selling author of the books The Food Medic and The Food Medic for Life. I'm passionate about maximising our health through how we live our lives, including the food that we eat, physical activity and stress management. We will hear from leading experts in their field who will be sharing evidence-based advice on how we can live healthier lives. And we will cut through the confusing information that we find online.

I like to think of myself as one of the first of a new generation of doctors. Hey everyone, it's Hazel here and welcome back to the Food Medic podcast. First of all, I want to say a huge thank you to everyone who has downloaded and subscribed. Thanks to you guys, we are the number one health podcast on iTunes here in the UK. Now today I'm joined by Dr. Anita Mitra, who is an NHS doctor specialising in obstetrics and gynaecology. She has spent many years undertaking medical research and recently finished her PhD on HPV, cervical cancer and the vaginal microbiome. Anita uses these skills to provide evidence-based information to a non-medical audience. She also loves trying to normalise awkward health-related subjects and helping women to feel at ease talking about their bodies. Oh, and her surname is

the Greek word for uterus. Anita, welcome to the podcast. Hi. First of all, a huge congrats on finishing your PhD. I feel like we should have a round of applause. Massive relief. Massive relief. Now, I want to, first of all, kick off the podcast talking about periods, and in particular, the loss of a regular period, also known as amenorrhea. I come across this quite frequently in practice, and I have quite a few young women who approach

me who have lost their period, and they're not quite sure why. Now, there are many reasons why this can happen. Some of them are due to underlying conditions such as PCOS, which we'll come on to later, or some which are lifestyle related. And so I thought we could touch on how our lifestyle can affect our cycle. Yeah, absolutely. I think that's a really good place to start. And I think that a lot of people don't realise that lifestyle can have an impact on gynaecological health. We always think of, you know, a period of something that just happens every month.

And we kind of forget everything from the belly button down. I think it's really important to just introduce this concept of why we have a period. And the reason we have a period is because we didn't get pregnant that month. We're shedding the lining which our body had prepared for a pregnancy. And that's the reason we have a menstrual cycle, because our body is every month trying to release an egg, make an environment where the pregnancy can survive. From an evolutionary point of view, there's lots of things that we do in modern life that really put a strain on our body and tell our body that, you know, now's not a safe time to have a period. And that might sound a bit extreme. So let me just sort of explain that a bit more.

So I think stress is something that people do realize is associated with losing your period. So there might be times when you've had a really stressful month at work, or maybe you've traveled a lot and gone across time zones and things. These are all stressful events that basically cause us to release lots of cortisol, which is the stress hormone, which interacts with the signals from the brain that go to our ovaries, and also via the adrenal glands. So lots of different glands in the body are influencing what the ovaries do, which is ultimately what causes us to have a menstrual cycle and have a period. So why does stress cause you to lose your period? Well, basically, it's again, from an evolutionary point of view, our body's having signals saying, it's not really safe to have a period. It thinks you're running from a lion when actually maybe you're running from 50,000 emails a day, lots of phone calls, deadlines, social events that you've got to go to and things.

So that's why stress can do it. But stress isn't always an acute psychological insult as we always think. So, you know, we might say we feel stressed. Psychological stress is one thing, but also a lot of things that we do, overexercising, maybe having erratic diet patterns. These are all things that also put stress on our body. And also, you know, another thing that you've talked about with a lot of other guests is sleep. Yeah. So lack of sleep, again, and not really respecting our circadian rhythm also put stress on our body. So ultimately, all of these little things that we do in our life, maybe one of them isn't so big

that we think that that's the single thing, but it's the additive effect of all of them, they can cause you to lose your period. So after someone rules all of the more sinister causes of amenorrhea with their GP, and they realize it might be down to their lifestyle and the stresses in their life what would be a starting point for someone to kind of take control again and maybe try to get back into a regular routine yeah I mean this is a question that I get asked a lot and I'm sure you do as well because I think it happens a lot in people who maybe you know social media users people who are really training really hard. A lot of comparisons, comparing yourself to other people. I think that can all have an impact.

So I think, first of all, if you are training really hard, do you need to reduce that? Do you need to train as hard as you're training? Are you compensating your training with rest? That's really important because, you know, I think a lot of people see, okay, that girl, she's been to the gym like five times, according to her Instagram account. So I need to do that. But do you actually and does that person actually go to the gym that many times per week is another thing to ask. So I think exercise is a really important thing. And people ask, oh, how many times is too many? I can't answer that question. And you know, that individual is the only person who can answer that

because it really depends on what else is going on in their life. Yeah. I think as well, sleep, you know, again, you've covered it really well in other podcasts. But, you know, if you're not getting a good night's sleep, if you're waking up feeling exhausted all the time, if you are consistently having late nights all the time, you don't have much sleep hygiene, you know, there's no pattern. I think that's, you know, a really big area to address. Diet wise, I've seen a lot of girls who've actually turned vegan who've lost their period. And I don't have a problem with veganism at all. You know, there's plenty of health benefits of having lots more plant based foods in your diet. But I have seen it happen. And it is essentially due to a lack of the nutrients that we need. You know, we need a lot of different micronutrients.

We need lots of building blocks in order to go through all of the different processes that are required to give you a healthy period. So yeah, definitely diet is also something to think about. And while we are on the topic of periods, let's chat about how our menstrual cycle affects our exercise performance. And are there key areas throughout our cycle that we should be maybe dialing back our training load and are there times where we can actually use our cycle to our advantage yeah that's a really interesting question and i think it really varies

from person to person first of all i get asked all the time is it safe to exercise during my period the answer is absolutely yes it's completely safe. If you don't feel like it, don't force yourself. But actually, during your period is when your levels of estrogen and progesterone are at their lowest. So during this time, you're actually able to mobilize your glucose stores in your body more effectively because of this change in the hormones. So there is some research to show that actually during your period, you're better at performing HIIT workouts. Oh, wow. So that's something pretty interesting.

I mean, personally, I haven't found a difference. But again, it varies from person to person. So, you know, if there's a time when you think, yeah, I really want to get a really good sweat on, really go for it, then maybe during a period is actually the time. If you don't feel like doing something like that, absolutely no problem. You know, do whatever you feel. But during a period, doing exercise actually can help with period pain as well. So that's something that people may find quite useful. In the week after your period, as your oestrogen levels are rising, we find that people are better at building muscles. So strength training may be better.

And around about the time of ovulation so that would be if you have a 28 day cycle that would be about day 14 that's probably when you're more likely to get a pb in the gym oh really yeah yeah everyone's going to be getting the pbs now i know exactly um and then after you ovulate that's when your temperature starts to rise a bit so some people might actually find that um you know doing doing HIIT workouts and things is really uncomfortable because they're just too hot. So, you know, that might be a time when you actually want to stick to more kind of endurance sports. And that's also because you're better at mobilizing fat stores at that time. So that's the best kind of energy to be using for endurance activities.

So I would say that track your cycle. So use a period tracking app. I really like an app called Clue. It's really simple, really easy to use. And just see, does it make a difference to you? Some people honestly will say, I find absolutely no difference on, you know, any days of my cycle. But, you know, you might do and maybe you want to use that to your advantage. Yeah. And I think using that app or a tracking device to just stay in tune with your body is quite a useful exercise anyway yeah definitely i mean i love apps because if a patient comes to me and gets their app out i'm like brilliant i can help them so much better because if they've kind of got in tune with their cycle and they know kind of which symptoms they're getting when yeah i really find it helps a lot. Absolutely and we're going to talk about apps a little later on

so we briefly mentioned PCOS or polycystic ovarian syndrome at the beginning which is getting a lot of attention recently particularly on social media there's a lot of people talking about it and I think for those who are unfamiliar with the term we should really go back to basics and chat about what PCOS actually is, how it's diagnosed and how we can treat it. Yeah, so as you said, it's polycystic ovarian syndrome. So syndrome means a collection of symptoms. So it's not necessarily the same thing in everyone. We have the Rotterdam criteria. So you need two out of the following three. So it's either having no periods at all or very irregular periods, having signs of too much

male hormones. So that might be male pattern baldness, acne, excess hair. And then the third one is having polycystic ovaries on an ultrasound scan. And sorry, just for the medical students, that question always comes up in exams. Definitely, learn that one. I remember that one coming up. So I think the reason why it's been getting so much media attention is that actually about one in ten women do have this syndrome. And it can cause quite a lot of problems because, you know, a lot of people get really worried. I'm not having a period. I'm going to be infertile. Or, you know, I've got this awful acne and it's due to my hormones. What can I do? And so it's important to be aware of it and for people to also get reliable information about it.

I've seen a lot of bad information written online. And if you Google it, it will basically tell you that you're going to be infertile. You're going to get diabetes and, you know, your life is over. That's the thing, the way it's portrayed, it's very scary. And also what I've seen is potential ways to treat it are a bit obscure. And I don't feel are evidence-based, particularly when it comes to various diets. So what I want to know and what I think the listeners want to know is, do we have any evidence for kind of dietary management of PCOS? And if so, what would you recommend? Yeah. First of all, I would

say that I think that there are a lot of people pushing quite extreme diets when it comes to PCOS. I think the ketogenic diet is something that has had a lot of things written about it online, and you covered it really well with Alan in a recent podcast. The thing I would say about the ketogenic diet in PCOS, there is science and there is theory to suggest why it will work because the idea is about increasing your insulin sensitivity because that is a problem and that's one of the drivers of PCOS. But I think that it's something that's really not sustainable for many people. You know, a lot of these ketogenic diets are telling people that they need to have maximum 20 grams of carbohydrates per day. Yeah. It's not very much. No. And I think as well, it's about quality over quantity. If you're having really good carbohydrates,

you know, things that have got loads of fiber, loads of phytonutrients. I mean, people just need to open your Instagram account, Hazel, and look at what you eat every day, because your diet has got, you know, all the perfect carbohydrates in. You're getting loads of fiber. You're getting all the colorful veggies in there. And that's what you really need for PCOS. That's more important than keeping it really, really low and trying to be in this ketogenic state. I mean, you and I are just never going to be, we probably don't make a single ketone at all. No, no.

And the thing is that, you know, the thing that's really important is that actually fiber, having a high fiber diet has been shown to be associated with a decreased risk of PCOS. Yeah. And a decreased risk of so many different health conditions, which is why I kind of got to be in my bonnet when people start pushing out severely low carb diets for kind of as a general population advice. I don't think we should be doing that. And that's not saying that for individual people it doesn't confer a benefit. Some people do find it's really beneficial, but as you've just quite rightly said,

there's no sustainability to it. And we know that we've got so much information and evidence to say that good quality, and quality is the key word there, carbohydrates that are high in fiber whole grains and you know like lots of different color that confers so much benefit and i think we need to remind ourselves of that and you know might say something in one study but when you take that to an individual it's not necessarily going to work exactly and these are young women i don't

want to make them you know fear carbohydrates i don't want to push a fatty diet. And to be honest with you, the diet that has the best evidence when it comes to PCOS is actually the Mediterranean diet. And furthermore, there are studies to show that the Mediterranean diet is one of the easiest to stick to. So when we're thinking about PCOS, we're thinking about, you know, we don't want fatty diets. We don't want crash diets. We want something that somebody is going to be consistent with and is going to stick to. So I think aiming for something more like, you know, Mediterranean diet with your whole grains, fish giving you your amigas, and then also lots of fiber and phytonutrients in your veggies, and then healthy fats, so important. Female hormones are made of fat.

Yeah. If you don't have the ingredients, you can't make the product. Yeah, absolutely. That's really important to mention and probably another reason why some people may find their periods are irregular if they're not getting enough fat in addition to not enough calories. Another common condition women suffer from is endometriosis. And I think people get quite confused between the two. And again, it's been chatted online quite a bit,

but I really want us to just give a clear overview of what it is and what women who have the diagnosis can do to help improve their symptoms. Yeah, I mean, I think endometriosis is something that people are really scared of. There's a celebrity recently who had a hysterectomy for endometriosis, which I think, you know, I've seen a lot of people really scared coming to clinic with the diagnosis saying, God, do I need to have everything taken out? Yeah, but that's quite an extreme case. Yeah, absolutely. And but this is the thing. This is what comes across in the media and what's really scaring people. So endometriosis is where you have the lining of the womb growing outside of the uterus, outside of the womb.

So it tends to be on the pelvis, so on the skin inside your tummy. It can grow on your ovaries. It can grow on the bladder, on the bowel, in very rare cases on the lungs. So this tissue still reacts in the same way to the female hormones. So it builds up throughout your cycle. And then when you have your period, it sheds. But when it sheds, it doesn't have anywhere to go. The blood that would normally come out, it's all in your tummy. So it causes a lot of pain. Blood is very, very irritating to that peritoneal lining, the skin inside the pelvis. And then it causes scar tissue, actually. And so when you've got scar tissue, it causes the internal organs to become stuck together. So they're not able to move around in the same way that they normally would yeah now it's it's again very common one in 20 some people say one in 10 women

have endometriosis and it causes very very heavy painful periods it causes pain just generally throughout the month if it's on your bowel for example it can cause pain when you go to the toilet to have your bowels open it can cause pain on intercourse that's one of the really big things and then also it can cause problems with fertility and that's obviously the thing that people worry about yeah there's a lot of things that you can actually do yourself though diet is really important if there's one piece of advice that i could give to people with endometriosis or who are worried they have endometriosis i would say you need to make sure you don't get constipated.

Because your bowel is there next to your womb and your ovaries and your tubes. Right next to one another. Absolutely. So if your bowel is continuously full, or you're really straining to try and empty it, that's going to cause pain. And if you've got that scar tissue on your bowel, then it's going to cause pain throughout the month all the time.

Another reason not to get constipated is because endometriosis is an estrogen-driven condition. And we get rid of a lot of excess estrogen in our stool. So if you are having a good poo, you're getting rid of the estrogen. And also, if you're having a good poo, it's often a sign that you're eating plenty of fiber. So back on the having a good poo it's often a sign that you're eating plenty of fiber so back on the fiber again but it's just so important that's helping your body get rid of it and also if you're having lots of green veggies for example some of the particular phytonutrients in those vegetables have been shown to help the liver with oestrogen detox so you know detox is something your body does naturally and so you get rid of the oestrogen also in the liver with estrogen detox. So, you know, detox is something your body does naturally. And

so you get rid of the estrogen also in the liver. Those kind of compounds will help. Yeah. So it's got, you know, something really simple as having a poo is going to actually help on so many levels. So I think it's really, really important. For high fiber. Yeah, definitely. I get asked a lot about uh whether people should go um gluten free and there's not really very good consistent evidence at a population level but it's something that people can try and i know a lot of my colleagues do i recommend that people try at

least um cutting out gluten so if that's something that you want to do you absolutely can you don't feel you have to but do it with a of course, because if you're cutting out gluten, then you're obviously at risk of endometriosis. And some quite interesting studies have shown that people who have plenty of dairy in their diet actually have a decreased risk. And the reason being, some people have hypothesized that it's due to the vitamin D. So vitamin D is a really, really important vitamin in the body because it actually plays a big role in the immune system and in inflammatory processes and the immune system and inflammation are both very very important when it comes to endometriosis and symptoms so if you're getting plenty of vitamin d then it's been suggested that actually you have a lower risk of endometriosis so i get a lot asked a lot about supplements as well and you wrote a really great blog post about this i mean you know i think vitamin d is really one of the few supplements that actually has evidence

to support its use so you know if there's something that you want to take i think vitamin d if you're deficient and we all are in the winter then that's a really good one to go for i guess to summarize you're saying a high fiber, gluten is a bit of a question mark over this one. And I think I would definitely kind of caution anyone who just kind of wants to jump into that without speaking to a healthcare professional because just going gluten-free and opting for gluten-free products doesn't necessarily mean that you'll have a high-fiber, healthy diet.

So speak to your GP, speak to any dietitians or nutritionists there's lots of us online who are available to speak to anyone and finally you said vitamin d supplementation so as of a kind of a blanket recommendation here in the uk we should be supplementing throughout the winter and spring months we usually get enough sunlight here in the summer we're definitely getting enough at the moment. I'm loving it. But that's just something else for people to bear in mind. So moving on from endometriosis to fertility, something which affects both men and women. Here in the UK, one in seven couples have difficulty conceiving, which is approximately 3.5 million people. It's quite a lot. Most people won't think about their fertility until they start trying for a baby.

But how does our lifestyle impact our fertility? And what should we be doing to look after our reproductive health even before we're thinking about babies? Well, I'm really glad you asked about this because I think that fertility is a massive taboo topic. It's funny, actually, because I was at a wedding a few weeks ago and the groom during his speech made reference to children. And he said, obviously, that's assuming we're not going

to be one of the one in seven couples who has trouble conceiving. And everyone was like, oh, my gosh, I can't believe you just said that. And you know, gynecologists, this is what we talk about at our weddings. Even on a table of doctors, we were like, wow, that's quite an interesting thing to say. But I just thought it was amazing, actually, to just get that out there that, you know, people do struggle with getting pregnant. And I think it's really hard for people when they see, you know, people just popping out babies all over the place. And, you know, people you know, probably are struggling to get pregnant and don't realize it. So if 100 couples try to get pregnant for a year, 84 will succeed. So it's a big problem.

So I'm glad you touched on the male factor as well, because we know actually that about 30% of infertility is due to female factors. 30% is due to male factors and the remaining 30 or so percent are unknown, but probably 50-50 between the two. So it really does take two to tango. Yeah. probably 50-50 between the two. So it really does take two to tango. And that's why I think when women are thinking about fertility, they need to be making sure that their men are also thinking about their lifestyle because lifestyle has a huge impact on fertility. There's a really interesting study that I read just last week that came out in June in a journal called Human Reproduction. And the title is pre-Pregnancy Fast Food and Fruit Intake

is Associated with Time to Pregnancy. So that's a pretty bold title. And so what this study was doing was just looking at what people ate before they were getting pregnant. And they found that people who had a lot of fast food were less likely to conceive quickly and that people who had plenty of fruit were more likely to conceive quickly. Okay.

Which is really interesting because I think that we're all a bit scared of fruit these days. You know, all this talk about sugar and people thinking that it's something that isn't actually that healthy. Yeah. But that's quite thought-provoking, that title, to me. And I think, really, we need to think about all aspects of the diet. And again, I'm going to talk about the Mediterranean diet. I know, we talk, we bang on about that all the time on this podcast. But there is so much evidence for it. So there are studies looking at both male and female

fertility and the Mediterranean diet. And they both show that this kind of diet promotes fertility in both groups. So if there's something you want to change about your diet, and they both show that this kind of diet promotes fertility in both groups. So if there's something you want to change about your diet, go Mediterranean. Yeah. Another thing I would say is that, you know, get asked a lot about supplements again, when it comes to fertility. Again, vitamin D is the only one that's been shown to be beneficial if you're deficient. There's a little bit of evidence for omega-3 rich diets, but again, I think it's all about the bigger picture, really, making sure that everything you're

getting into your diet is giving you some kind of health at some level, not just trying to pick out one specific thing. Exactly. I look at the whole diet and I think having the food first approach and then supplement as necessary. I actually go into that quite a bit in my new book because I'm not totally for supplements I think if we can avoid them then we should try to and try to get as much as we can from our diet but then that comes with a caveat that if you are cutting out foods for whatever reason whether you're vegan or anything else then do make sure that you're getting all your your. And if you're not, then supplement definitely. Definitely. And, you know, there are a lot of people online trying to

push supplements for fertility. And it really upsets me, actually, because these are people who are really quite desperate to, you know, get pregnant. But they're being sold quite expensive supplements for which there's no evidence whatsoever. And so I think you just have to be really careful because if there's no evidence for it, you're wasting your money and you might as well just look at other things in your life. I get a lot of people coming to clinic who have quite unhealthy lifestyles and they say, well, isn't there a pill you can give me? No pill is going to be as effective as making you diet better making sure you're getting regular exercise sleep is also a massive thing when it comes to fertility yeah because again it's that whole impact of sleep causing your body to feel stressed and then your hormones not working in the way that you want them to and how about alcohol alcohol is just a big no-no i know

everyone says oh i know that person who was drinking all the way through until they realized they were pregnant at you know maybe five or six weeks but yeah okay everyone's got those anecdotal stories but as a healthcare professional i think we just can't advocate for drinking um during pregnancy yeah absolutely get asked a lot about caffeine as well yeah um and actually there's no strong links between caffeine and um difficulty getting pregnant um but there are quite a few studies that have come out in the last few years suggesting that having lots of caffeine is associated with a high risk of miscarriage earlier on in the pregnancy.

So, you know, if you're thinking that that's something that you want to start getting pregnant and you drink a lot of coffee, you know, now's the time to start trying to cut down. And what is the recommended daily amount of caffeine for a pregnant woman so two cups a day that's it that's all um and it's not just coffee as well so things like yeah tea green tea chocolate coke all those kind of things so you know start to get a bit savvy you know when it comes to looking at labels and things um just to see where your hidden caffeine might be coming from yeah even those um fancy superfood lattes i'm sure absolutely okay so just following on from fertility many women also like

express concerns that hormonal contraception such as the pill will affect their fertility i'd love to know your thoughts on this yeah this is something that i see a lot of people really worried about a lot of women these days are coming to me saying, I've been on the pill for too long. There isn't any evidence to say, you know, what's too long. The way that people have studied this is basically looking at pregnancy rates after stopping contraception. So when you stop the pill or any other kind of hormonal contraception apart from the injection, you have the same pregnancy rates and the same time to pregnancy as people who have been using non-hormonal methods. I mentioned about the contraceptive injection.

So that's an injection that normally lasts for three months. But there is a little delay in time to pregnancy after stopping the injection because we don't know that it is completely gone well it won't be basically you can guarantee that the injection will last as a contraceptive for three months but after that period there will still be some still dissolving away in your body and so that's why we know that after stopping the injection it can take a little bit of time and to conceive afterwards yeah so adding to that we know that the injection, it can take a little bit of time to conceive afterwards. Yeah. So adding to that, we know that the injection is like a really useful form of contraception. But if you are at that period of your life where you're thinking, maybe I'll have a baby in a year or six months, might not be the best form of contraception to jump into.

Exactly. But one thing I would say is that, you know, if you've used it as a teenager or, you know, in your early 20s and, you know, a couple of years down the line, don't feel worried. Using it, you know, historically doesn't impact on your fertility at that point. It's just for those immediate few months after you stop it. And as we're on the topic of contraception, let's briefly talk about natural contraception and all of these apps that are coming out. Now, we've covered this over on the Food Medic blog, but I want to chat to you about it and your thoughts on these apps and, I guess, covering any pros and cons that come with it. Yeah, absolutely.

And the blog that you posted recently is excellent, so I think everyone should read that if they want a bit of a background of how they work. But essentially they work by trying to predict when you are fertile and then they tell you that you're fertile, so you shouldn't have sex or you're not fertile at the moment, so it's safe to do so without using any other contraception. So if you are using them, you will still need to use condoms during the fertile time if you want to have intercourse.

So that's something that a lot of people don't actually realise and actually puts some people off completely because they just don't ever want to use a condom. But I have to say that at the moment, they're not recommended on the NHS. And I don't think that they will be anytime soon because there isn't really enough evidence for us to be able to recommend them to the general population. There are a couple of published studies published by the company who make these apps showing how effective they are.

But, you know, we have to remember, first of all, that if the study published by the person who make these apps showing how effective they are. But, you know, we have to remember, first of all, that if there's a study published by the person who made it, you have to... Alarm bells. Yeah, it is a confounder, okay? And then also we have to remember that the people who are taking part in the study are not necessarily representative of the general population.

These are very motivated people who've been given the app to use and they may not have the same kind of lifestyles that we're all leading. So my kind of general advice on this would be if you're somebody who has a very, very strict schedule, you wake up every day at 7am, you go to bed every night at 10pm, you're not traveling all over the place, and you're not having bouts of stress on and off. And, you know, maybe then for you, it might be appropriate. But for a lot of people, there are so many things that we do in our daily life that affect when our fertile period is.

We're not terribly good at predicting the fertile period, to be honest with you. So these apps are also not very good. You know, we are far more complex than a computer algorithm. So that's something to be really aware of. And also, when you're predicting the fertile period, you're fertile for five days before you actually ovulate. So if you ovulate too early and you've had sex, then you're, you know, you're at risk of getting pregnant. And so you can't ever account for that. It's just if it happens too early it's happened and and you know you're at risk of pregnancy so it's a little bit risky but if people take that on board and they're happy with that then that's absolutely fine as long as they do use other

protection if they want to have sex during their fertile period yeah if you have pcos in particular it might not be very reliable at all and you might find that it really just doesn't ever predict your fertile period. Because when you have PCOS, you're actually having lots of spikes of a hormone called LH, which causes your temperature to go up. And that's what these apps are largely looking for. So it probably won't predict very well. It will get quite confused by your cycle. So it probably won't be very effective,

which is why even in the studies that the makers have put out they have a 56 dropout rate because people don't find the app to be useful enough for what they want yeah yeah and i think i want to be super clear with everyone it's not like i'm totally against this app or anything but i just don't feel like the information is being shared completely online and the brand or company behind this are working very closely with influencers to promote it and that's fine but I think we need to make sure that everyone's getting the right information because it's quite trendy to do everything natural now natural skincare natural hair care natural contraception yes that's fine but when

we're thinking about that who we're influencing and young girls who are not ready to get pregnant yet and maybe haven't thought completely about how this app may not be the perfect thing for them we need to ensure that they have that piece of information before they decide to come off their pill or whatever they're on yeah absolutely and i always say it's fine if you would not be devastated if you got pregnant yeah that's i have no problem with it but if you would not be devastated yeah and now i want to finish on a topic that is probably not at the forefront of many young people's minds but something i think is relevant for a lot of people listening, and that is the perimenopause and the menopause. I think it conjures up a lot of anxiety for women,

and that's largely due to the symptoms like hot flushes and changes in mood. So I would love to chat through what we can do to help women who are going through this phase of their life in terms of dietary and lifestyle factors. So I think I'm really glad that you asked me about this because there's not a lot of great information out there about the menopause. The menopause is the day when it's been exactly a year since your last period. And the average age for that to happen is at 51 years of age in this country. It's largely genetically determined though. So in order to get an idea of when you

might go through the menopause, you should ask your mum because that's the best way to get an estimation so the perimenopause is the stage leading up to this one year of no periods and it can last for a couple of months or even several years so yeah you really touched on all the main symptoms that everyone's aware of so yeah hot flushes and mood changes tend to be the main things that people think about. Weight gain can be a problem, lack of energy as well. So there are a lot of things that you can actually do lifestyle wise. And this is something that we need to be bearing in mind from a young age, because you want to make sure that you are respecting your hormones all the way throughout your reproductive life. And then theoretically, they should respect

you when you're going through the perimenopause and the menopause. You know, really thinking all the time about good diet, reducing stress and making sure that you're active. When we talk about dietary factors and the menopause, a lot of people are quite interested at the moment about phytoestrogens. So these are natural plant-based estrogens and they can actually be really effective. So we're talking about things like flax seeds, sesame seeds, lentils, anything soy-based. And again, I saw you had a really nice article on your blog about soy, which I think people should definitely read because, you know, some people think, oh, soy, estrogen, that's going to cause all sorts of problems. But actually, it's really helpful. There are some supplements that there is a little bit of evidence for. So red clover is particularly

one of them. So that might be something that people want to look at. But it's, you know, that's a phytonutrient rich compound. And so again, it's all about getting a really colourful diet and getting all those nutrients that are going to help your hormones at that time when everything is going a bit haywire. Exercise is really beneficial. I've had a lot of patients who I've talked about, you know, starting something like yoga or Pilates who are in the perimenopause and they all kind of look at me like, is that really going to make a difference? But it absolutely does. And I've had so many people come back and they say, I actually tried it and I really enjoyed it. These are people who are, you know, very busy women, have families that they have to look after, busy jobs.

Just doing something for a few minutes a day for yourself can have such a massive impact. And, you know, I've sent a lot of people to like YouTube channels with yoga workouts and things that they can do. So it's something that you can do in your own home even. You don't have to be going to a class or something. It's not something to, you know, make your schedule even more hectic. You know, just taking that time for yourself. Smoking is something really important to just mention here as well, actually. It's been shown that people who smoke actually go through the menopause earlier. Now, you might think, okay, great, I can stop having periods earlier. They're a bit annoying. I want to get rid of them. But actually, there are some risks to going through the menopause.

When you go through the menopause, you have a higher risk of heart disease and also a higher risk of osteoporosis. So these are the things that we want to try and negate. And again, that's where exercise comes in. You need to be active during your younger years because you need to build that negate. And again, that's where exercise comes in. You need to be active during your younger years because you need to build that bone strength. Because after you go through the menopause, you're not going to build any more bone at all. So you need to be loading your joints. So, you know, doing something like even walking is, you know, if you're not doing anything,

walking is absolutely better than nothing. But something to build up bone strength while you're young to carry you through the menopause and make sure that you're not getting you know stress fractures or fractures from just trivial trips and falls so yeah I think really my my biggest piece of advice would be making sure you're getting all these phytoestrogens and you know plant-based nutrients so trying to maybe add some more plant-based foods into your diet, having some time for yourself, managing your stress, and then definitely not smoking. And before you go, I like to ask every podcast guest their three top healthy hacks. So I'd love to hear yours. Yeah, okay. So I think the first one would be about having some kind of time to yourself, mindfulness. You know, there's a lot of talk about meditation these days.

When I talk to patients about it, they're a bit put off by this idea of like, you know, maybe having to like go into like a darkened room with a candle flickering in the background and like having to chant or something. And they're gone. Yeah, exactly. But I think that we can, you know, overthink this idea of meditation

and you need to think about how you can get it into your life. So I think of it to myself as quiet time rather than meditation so it's just you know doing something really simple like going out for a walk 10 minutes 20 minutes but not taking your phone yeah not having that constant stimulation sort of a little rule that i've made for myself these days is having my quiet time in the car on the way home from an on-call so if we do an on-call shift and it's a 12 and a half, 13 hour day of just constant noise, constant stimulation, phones ringing, bleeps going, people crying, you know, someone being really annoyed about something, you know, feeling stressed because, you know, you need to be in five places at once. But then I'll finish work

and it's 9pm and I need to go home. I need to have my dinner, get ready for the next day. And so what I do is I, when I'm driving home, I don't put the radio on. I don't listen to any music, any podcasts. I just have that time to just let the day kind of wash over me. And, you know, it's something so simple, but I've actually noticed that I'm sleeping a lot better because of it. But previously I would have thought, I don't have time to do any kind of mindfulness or meditation or anything, but, you know, just something as simple as not having any stimulation in the car really helps me. Yeah, that's so important. It's something that I really, really try now before I go to bed.

And it was so difficult beforehand. But now I'm really in the swing of things where I really don't want to look at my phone before I go to bed because I know that there will be a message or an email or something that will kind of trigger some kind of thought in my head. And it's so much nicer to finish your day on a good thought, whether that's writing down something you're grateful for or reading a book and you're thinking about something completely different and then you just have a nice restful sleep. Yeah, definitely. I think that makes such a massive difference. My second one would be seeing having a healthy lifestyle as adding something to your life,

not restricting. I've noticed when I talk to patients about, you know, being healthier, they're like kind of thinking, oh, gosh, she's going to tell me I can't have all the things that I like or, you know, she's going to tell me not to do this and not to do that. But I always say, right, okay, so what can we actually add and all these good things that you're adding constantly reminding yourself of why you're doing it I just think it gives a more positive spin on trying to be healthier and I also think that it makes you more likely to stick to it because then you're kind of subconsciously giving yourself a little high five every time you add some more veg to your dinner that's a tiny little bit of positive reinforcement that i think psychologically makes these kind of changes a lot easier yeah

and then also you know if you're forcing yourself to do something it's probably not right for you yeah so for example like exercise there's so many different kinds of exercise i mean some people like running some people like we love weightlifting you know some people love pilates just try different things yeah I keep saying about YouTube but there's so many great workouts on YouTube where you can just try it you don't even have to leave your own home you don't have to worry about you know going to a gym or something just try so many things you know you might surprise yourself I never thought I'd like weightlifting but I absolutely love it yeah so yeah just if something's not right, don't force it. Try something else.

My third thing would be really don't be afraid to educate yourself. Obviously, my name on social media is Guiney Geek. So I think it's quite cool to be a geek. But you know, I think that there's so much information out there these days. And I think when people understand what's going on with their bodies, it really decreases the amount of anxiety but I would caveat that by saying just be aware of who's writing that information okay that's always something you've got to have in the back of your mind is this person qualified and do they have an ulterior motive so are they actually

trying to sell you something are they doing it for the right reasons? So do read, but do look at who the author is. Who are they and why are they writing it? Yeah, I think that's super important. Great. Well, thank you so much. Before you go, it's been such a pleasure having you on. Really, really lovely. Always nice spending time with you. But can you please let everyone know where to find you? I know you just mentioned your Instagram handle. Yeah, so you can find me on Instagram and Twitter at gyne geek so g-y-n-a-e-g-e-e-k and then my website is gynegeek.com where i write a few articles and do a few um youtube videos explaining things so yeah check it out amazing and that is the end of today's episode. So if you did enjoy it, please do leave us a review and a five star rating if you feel compelled medic podcast please do subscribe so that you are the first to hear about any new episodes and if you are enjoying them please leave us a five-star

rating and a review so that we can reach as many people as possible check out my website thefoodmedic.co.uk where you can find tons of recipes and articles. Follow me on social media, Instagram, Twitter and Facebook at The Food Medic. And my new book, The Food Medic for Life is out now, which is packed full of loads of recipes, nutritional advice, myth busting and feature pages on topics such as sleep and mindfulness. You can grab both my books on Amazon or in any good bookstore. Thanks for listening and I'll see you next time. Thank you.